Ankle & Lower Leg

What It Is

A pilon fracture is a break at the bottom of the shinbone (tibia) that affects the weight-bearing surface of the ankle joint. It is also known as a plafond fracture. The other bone in the lower leg, the fibula, is frequently broken as well, in about 75 to 90 percent of cases (American Academy of Orthopaedic Surgeons, n.d.; Mair et al., 2021). In many pilon fractures, the bone is crushed or split into several pieces because of the high-energy impact that caused the injury ("pilon" is the French word for pestle, a tool used for crushing) (American Academy of Orthopaedic Surgeons, n.d.). These fractures are usually caused by high-energy events such as car accidents or falls from a height, and occasionally by lower-energy twisting injuries such as skiing accidents (American Academy of Orthopaedic Surgeons, n.d.; Mair et al., 2021). Because of the amount of energy needed to cause this fracture, people may have other injuries that need treatment as well (American Academy of Orthopaedic Surgeons, n.d.).

Pilon Fracture of the Ankle Anatomy

Three different bones compose the ankle joint: the shinbone (tibia), the smaller bone within the lower leg (fibula) and the small bone nestled between the heel bone and the fibula and the tibia (talus) (American Academy of Orthopaedic Surgeons, n.d.). Doctors will look at how many pieces the bone has broken into, how far the pieces have moved, and how badly the skin, muscles and tendons around the break are injured (American Academy of Orthopaedic Surgeons, n.d.). Two joints are often involved when a fracture occurs: the ankle joint, which is where the talus, fibula and the tibia meet, and the syndesmosis joint, which is between the fibula and the tibia and held together with ligaments. It takes multiple ligaments to ensure the ankle joint is stable.

How a Pilon Fracture of the Ankle is Treated:

Many pilon fractures need surgery, but some can be treated without an operation. Whether surgery is recommended often depends on how far out of place the broken pieces of bone are. Non-surgical treatment is usually kept for stable fractures, or for people who are not well enough to have surgery (American Academy of Orthopaedic Surgeons, n.d.; Mair et al., 2021).

Monitoring

The doctor will monitor the healing of the fracture closely. You will be required to return to the clinic regularly to have repeat X-rays and make sure the ankle stays stable throughout the healing process (American Academy of Orthopaedic Surgeons, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Options outside my scope

Surgery (internal fixation): the broken pieces are put back into position and held together with metal plates and screws. If there is a lot of swelling or blistering, the operation may be delayed until the swelling goes down (American Academy of Orthopaedic Surgeons, n.d.).
External fixation: metal pins are put through the bones and attached to a frame outside the skin to hold the ankle in a good position, either until a second operation can be done or sometimes as the only operation (American Academy of Orthopaedic Surgeons, n.d.).
Splint and cast: for stable fractures, the doctor will usually apply a splint first and then, once the swelling has gone down, a short leg cast, which may need changing as the swelling changes. Later the cast may be replaced with a removable brace (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

Easing the areas working overtime while your ankle is protected
Swelling, stiffness and scar work once your team allows
Rebuilding ankle movement, strength and balance

Recovery

You will not be able to put your full weight on the ankle for some time, often around 2 to 3 months. Follow your medical or surgical team's own instructions about putting weight on the leg and when to start moving the ankle (American Academy of Orthopaedic Surgeons, n.d.).

Rehabilitation

Once your medical team allows, I can support your rehabilitation with hands-on work and exercises to ease stiffness and rebuild the movement and strength of your ankle. See the My Approach tab for how I work.

Rehab is crucial following a pilon fracture. The injury is complicated and requires expert medical care to manage the rehabilitation to ensure return to sport. Physical therapy exercises help improve the movement and strength of the ankle, and because the ankle can keep improving for up to 2 years, it is important to keep doing your exercises even after formal therapy has finished. Ankle stiffness is very common afterwards, and some degree of arthritis develops in about half of people with a pilon fracture (American Academy of Orthopaedic Surgeons, n.d.).

Tips

Most pilon fractures happen in people at around 45 years of age, and men have them slightly more often than women (Mair et al., 2021).
Even though airbags can help to save your life in an automobile accident, they don't protect your legs, and many survivors of high-energy crashes have pilon fractures and other leg injuries (American Academy of Orthopaedic Surgeons, n.d.).
Falling from an elevated height can leave you prone to one of these fractures (American Academy of Orthopaedic Surgeons, n.d.).
When skiing, your legs and ankles are susceptible to injuries. Try to exercise caution when skiing down the hills at excessive speeds.
If you play high-impact sports, you may be able to return about 6 months after your injury or surgery, and manual workers typically need 4 to 6 months of rehabilitation before going back to full duties (American Academy of Orthopaedic Surgeons, n.d.).

Treatment

My Approach

After a pilon fracture, your fracture or surgical team leads your care. They decide on surgery, how long you're in a cast, boot or frame, how much weight the leg can take and when the ankle may move. I work inside those limits and need your medical team's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

While the Ankle Is Protected

Easing your hips, back and other leg, and your shoulders and arms if you're on crutches
Gentle lymphatic drainage above the cast or boot, clear of wounds and pin sites
Keeping your hip, knee and toes moving, and help with crutches or a walker

Once Your Team Clears the Ankle to Move

Hands-on work for the calf, shin and foot, and scar work once wounds have fully healed
Gentle ankle movement within your team's limits; stretching or resistance across the fracture waits until the bone has healed
Warmth for stiffness, but no heat over metal implants
Cycling, balance work and calf raises, building to gym-based strength as weight-bearing allows

If pain, swelling or numbness keeps increasing, or a cast feels too tight, call 911 or go to the emergency room.

What to Expect

Typical Course

Typical course: Once you're cleared, most people come once or twice a week at first, then weekly, with a reassessment at about 4 to 6 weeks, then less often. Full weight-bearing often takes around 2 to 3 months, and a return to high-impact sport about 6 months, following your team's plan.

What I Focus On

Working Within Your Team's Limits

Compensation Relief

Swelling & Scar Care

Ankle Movement

Strength & Balance

Please read

When to See a Doctor First

When to get urgent help

Pilon fractures usually cause immediate and severe pain, and the ankle may look angled or crooked (American Academy of Orthopaedic Surgeons, n.d.). If you think you have broken your ankle, call 911 or go to the emergency room at your nearest hospital. This is especially urgent if bone is sticking out through the skin or a wound goes down to the bone (an open fracture), because of the risk of infection (American Academy of Orthopaedic Surgeons, n.d.).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Pilon fractures of the ankle (OrthoInfo). Available at: https://www.orthoinfo.org/diseases--conditions/pilon-fractures-of-the-ankle/ (Accessed: 7 October 2026).
Mair, O., Pflüger, P., Hoffeld, K. et al. (2021) 'Management of pilon fractures—current concepts', Frontiers in Surgery, 8, p. 764232. doi: 10.3389/fsurg.2021.764232

Massage therapy · Kitchener–WaterlooPilon Fracture of the Ankle

What It Is

Pilon Fracture of the Ankle Anatomy

Monitoring

Self-Care & Treatment

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Recovery

Rehabilitation

Tips

My Approach

While the Ankle Is Protected

Once Your Team Clears the Ankle to Move

Typical Course

When to See a Doctor First

When to get urgent help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPilon Fracture of the Ankle

What It Is

Pilon Fracture of the Ankle Anatomy

Monitoring

Self-Care & Treatment

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Recovery

Rehabilitation

Tips

My Approach

While the Ankle Is Protected

Once Your Team Clears the Ankle to Move

Typical Course

When to See a Doctor First

When to get urgent help

References

Related Conditions

Achilles Tendon Rupture

Ankle Fracture

Ankle Fractures in Children

Internal Tibial Torsion

Book a session